There are many things not factored into the graphs. Two that have been substantially quantified in healthcare economics literature:
- Average survival rates and outcomes for non-trivial procedures and illnesses are excellent in the US compared to the rest of the developed world. If I have cancer in the US, my average survival rate is 65-70%. In the UK NHS, to use that as an example, it is 45%. The better diagnostics, treatments, and options in the US are naturally going to cost more money and Americans have it to spend.
- The free-rider problem with pharmaceuticals. The vast majority of R&D cost is recovered in the US because it is one of the few markets in the developed world where drug companies can charge enough money to amortize their R&D costs. If Americans paid as much for drugs as the rest of the world, the pharmaceutical companies would go broke.
That said, there are an enormous number of aspects of healthcare in the US that are just grossly inefficient, wasteful, and expensive. Americans pay an inordinate amount of money for healthcare, and more than they need to, but they also receive some benefits in terms of medical outcomes as well.
Cancer survival rates are indeed quite good in the US compared to some other countries. However, that is not reflected in low cancer mortality rates.
Cancer survival rates generally measure how many people are alive five years after diagnosis; because in America, cancer diagnosis is performed early and often, cancer is often diagnosed early, and more patients will be alive five years after an early diagnosis than five years after a late diagnosis.
However, this does not necessarily lead to a measurably lower cancer mortality rate (the number of people who actually die from cancer) [1]. Furthermore, aggressive diagnostic procedures can also lead to false positives, unnecessary treatment, and overtreatment. Prostate cancer is a prominent example here: it is rarely fatal; it's a cancer that one generally dies with, not from. Conversely, surgery at the typical age where prostate cancer occurs carries significant risk and has, even when successful, negative effects on quality of life, such as incontinence and bowel problems.
The free rider problem with pharmaceuticals is largely a myth. Pharmaceutical companies typically invest only a relatively small percentage of their revenue (for Pfizer or Merck, about 15%, give or take) in R&D. I.e., out of every $10 that you spend on their prescription drugs, only $1.5 will go to research. Furthermore, most of the basic research (north of 80%) to discover new drugs and vaccines is actually funded by the NIH; Pfizer, Merck, etc. are more interested in variations of existing drugs than in innovating treatment [2].
People diagnosed with cancer are obviously more likely to die of cancer, since cancer is never cured, and everyone must die of something. What matters is how long they live with their cancer. That is why survival rates are a better measure of cancer treatment efficacy than mortality rates.
The problem with that is that cancer survival rates are measured from the time of diagnosis, not from the time the cancer presumably began (because that's often difficult to tell). And even with identical treatment efficacy, cancer that is diagnosed early will have a higher five-year survival rate than one that is diagnosed later.
In short, we're lacking good data at the national level to measure what you'd like to measure; and we do have studies (e.g., the one in the first link I gave you) that at the very least cast doubt on the belief that an aggressive cancer screening schedule reduces cancer-related or all-cause mortality. As Robin Hanson puts it: "While cancer screening does consistently lead to more cancer detection and more cancer treatment, it consistently doesn’t lead to lower mortality."
There won't be identical treatment efficacy, because cancer treatments work better the earlier they are started. Early diagnosis is not a data problem, it is an inherent part of why the U.S. gets good results fighting cancer.
Cancer is never cured? An early find of some cancers will have you living longer, due to increased awareness and vigilance. And why is survival a better measure than mortality? 2 sides of the same coin?
Do you have any publications or links to back up your cancer survival claim?
Thanks
edit:
Found this:
Global Cancer Statistics, 2002 DOI 10.3322/canjclin.55.2.74
That shows essentially the same survival between the US and western Europe. (Link to table http://i.imgur.com/UWPxDEx.png )
This claim on survival just does not stand up to what I have seen as someone involved in the medical field.
It's too much and it is my understanding that american health outcomes are definately no better and in many cases a lot worse (for example childhood mortality)
You're cherry picking here by focusing on the UK in your first example. There are plenty of nationalized healthcare nations that have 5 year survival rates that rival (and in some cases surpass) the United States.
As for the second point, I'm not ok with subsidizing the rest of the western world. Set reasonable limits here and let them pick up the slack.
If I have cancer in the US, my average survival rate is 65-70%. In the UK NHS, to use that as an example, it is 45%
Do you have any links to studies that show this? The 20% gap seems extreme.
better diagnostics, treatments, and options in the US
It's really hard for me to believe that the US has better treatments than other 1st world countries which would result in 20%-30% decrease in mortality across the board. Once again I'd like to see some evidence.
I could maybe understand if the US had much higher rates of testing which in turn resulted in higher rates of survivability.
Many of these claims seem grossly over inflated. I'd be interested to see where you got the figures from.
The statistics actually come from the esteemed British medical journal Lancet. Google it; the over-performance of the US across a broad swath of cancers in that study attracted a lot of attention.
As for why the US has better treatments, depending on how you measure it, 70-80% of all new biomedical R&D globally is done in the US. Consequently, if there is a new biomedical technology, it shows up in the US system first where they can capture the R&D investment. Most of the rest of the R&D is done in Asia.
You are correct about one thing: the US has extremely high levels of diagnostic testing compared to the rest of the developed world. It is both part of the cost and also why survival rates are higher for many diseases. The survival rates are not just better treatments, it is also earlier diagnosis by virtue of heavy use of (expensive) diagnostic tests.
"The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance."
The US doesn't have a monopoly on medical innovation; Many of the big pharma companies are European:
Of the top 12 Pharma companies 6 are from the US, but fully 50% are from European countries
(http://en.wikipedia.org/wiki/List_of_pharmaceutical_companie...)
Many medical innovations have come from countries other than the US, and they continue to.
This would suggest that a significant percentage of the excess costs are going to medical innovation; instead at each step along the way (from hospital to insurer to reseller to medical device and pharmaceutical company) 15-30% is skimmed in admin and billing fees and other overhead.
It is a total myth that the US is either the sole innovator or the sole supplier of funding for medicine.
So who does fund significant medical research?
On the most part private institutions (think howard hughes medical institute) and universities and their endowments, and federal and state government grants.
There are significant research partnerships with pharmaceutical companies and they do spend huge numbers on R&D but significant quantities of this are iterative rather than truly innovative, which is work that is done more often by PhD's and postdocs as they have more to gain and less to loose by going out in a limb with their research.
And this research goes on in every country in the world.
The US may account for more than the rest of the world's aggregate defence spending but it is stretching it to suggest that the same is true for medical research.
Everything from basic cancer therapies to stem cells to the human genome were invented / discovered / cracked by US money. And it's a very, very long list that covers most types of advanced drugs and therapies in some form or another. Growing organs? Pioneered by US research. Robotic surgery? US money.
It is however true that a lot of US medical costs are tied up in labor, namely healthcare workers and administration. Nobody wants to talk about what happens when you cut costs there however (unemployment, lower wages, et al.).
